HomeMy WebLinkAbout2005-096 Requisition - Eden Systems
CITY OF ASHLAND
REQUISITION
Issued PO #
Change Order for PO #
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Address 9 D b() 'f Lo 1 8 b.l- \0
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Date
Requested by C"J-itM ~
Requested Delivery Date
Deliver to
Item # Quantit
Unit Price
Total Price
Solicitation Process:
kI Sole Source .. **************************************************,It**************
^ Reason 1:+ \ ~ ~ QJ 0r1l4 n (\{,tJ\u.~t S kh).u,c. ~ t~k:fY\
Dept Head Signature Print Name Le'- / u A/!;da ,e.C-
o Contract (Original signed copy attached) - O( I Cjl
Start Date :r- - { - q 1 U IrS tv { a.G\;
Completion Date A f~ Orl 11;
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Insurance requa~ements: f..-l UJIIM ('
01_ Exp.D~e
,
Exp. D,ate
Exp. D,ate
Exp. Date
Contractors License Number: ~
City Business License Number: -4
o Less than $5000, not required
o 3 Written Quotes (Copies attached)
o Invitation to Bid (Copies on file)
o Request for Proposal (Copies on file)
If exempt or sole source, please provide reason
and have Department Head sign below.
~ Exempt
Reason
Dept Head Signature
o Budgeted for current fiscal year.
Sign Name ~ ~
Department Head 0 uthorized Person
Account Number:
Date
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CITY RECORDER'S COpy
CITY OF
ASHLAND
20 E MAIN ST.
ASHLAND, OR 97520
(541) 488-5300
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05982
VENDOR: 000064
EDEN SYSTEMS, INC, TYLER WORKS
POBOX 678076
DALLAS, TX 75267
SHIP TO: Ashland Finance Deartment
(541 ) 488-5300
20 E MAIN STREET
ASHLAND, OR 97520
FOB Point:
Terms: Net 30 days
Req. Del. Date:
Speciallnst:
Req. No.:
Dept.: PUBLIC WORKS
Contact: Lee TuneberQ
Confirming? No
()';Account NumbEtr:;;t(
~- 6/-5%r
. Aut I d Signature .
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VENDOR COpy